A Hands-On Workshop: Making Assistive Devices for Disabled Children
CIREC and ICES—the two groups that invited me to Bogota—joined together to organize a full day hands-on workshop in appropriate assistive technology. Representatives from both programs took part. Altogether there were about 30 course participants, plus 7 disabled children and their family members. Participants were selected with the idea that they would later function as teachers or “multipliers,” sharing with others what they would learn. Included were several of the landmine amputees, an assortment of rehab professionals, and a number of facilitators and young trainees from ICES. A valuable addition to the motley group were 5 nuns from programs that help disabled children, and who are “mediators” for assistance from Stichting Liliane Fonds in Holland.
The workshop was held at the CIREC Rehab Center in Bogota. As facilitators, CIREC staff—disabled and non-disabled—had generously gathered together the necessary simple tools and supplies. For teaching purposes, UNICEF filmed the entire workshop.
Several days before the workshop I had joined some of the participants in visiting the homes of disabled children for whom we would be making assistive devices. Home visits are essential for understanding the environment where the children live.
Participants can explore with the children and their families how to design an assistive device according to the unique limitations and possibilities in the home and community. For me as a stranger to the area, these home visits proved enlightening. We found that for many of the children and their families the biggest problem was accessibility. For example, two brothers with muscular dystrophy lived in a cramped hut on a steep hillside. They had to climb nearly 50 steps to reach the front door. This made wheelchair accessibility almost impossible. Any form ofmobility for persons who can’t walk would be a major challenge.
During the workshop participants divided into 7 small groups. For broader exposure, persons from the same program were placed be in different groups. Each group worked with one child and his or her family member(s).
The Goals of the Hands-On Assistive Technology Workshop
Demystify the process of making simple but functional aids,
Encourage innovative problem solving as a group process,
Observe how important it is for rehab workers to interact with family members and disabled children as partners and equals in the problem-solving process,
Utilize local low-cost materials and simple tools in the creation of useful devices,
Find out ways to adapt to the limitations and possibilities of the individual child and family in the environment where they live,
Discover that making simple aids as an interactive process can be an exciting adventure,
Look for ways to make assistive or therapeutic devices that are functional and fun,
Learn collectively from our successes and mistakes.
The 6 Stages of the Workshop
Pre-workshop home visits: Each small group visits the home of the child it will be working with, to make friends with the child and family and to observe possibilities and limitations. They listen to what the child and family say they want and need, and discuss/explore possible solutions and relatively simple technical aids.
First hour of workshop: design. Each group —including the participants, child, and family member(s) —designs the assistive device(s) they plan to make, and makes line drawings of it on large poster-paper.
Initial plenary session: Each small group presents and explainsits plans, shows its designs, and identifies the local, low-cost materials it intends to use. The larger group provides feedback and suggestions.
In the shop: Each small group constructs the assistive device, working closely with the child and family, in a trial and error approach. They use whatever local materials (cardboard, boards, plywood, string, paste, etc.) and simple tools are available.
Closing plenary: Each group, with the child and family member central to the process, presents the assistive device and how it helps the child (if indeed it does). In a sort of all-group evaluation, further suggestions are made.
Post-workshop follow-up: It is important that when the aid produced is inadequate or incomplete, that the program organizing the workshop makes sure there is adequate follow-up so that the child and family end up with something that really helps them do things more easily and enjoyably.
Helpful Suggestion: When Choosing the Children to Make Aids for this Kind of Workshop
Select children who can benefit from a simple device that can be made with local low-cost materials in 2 to 3 hours,
Select at least some children who can express their wishes, so the child herself can participate in the problem-solving process (and perhaps in making the device),
Choose children who get along well with strangers, who are cooperative, and who are likely to enjoy all the attention and to endure the long session. (Be sure to make provison for naps, refreshments, food, and quiet-time, as needed),
Select children who have a wide range of problems and needs, so that a spectrum of different assistive devices can be made and presented by the various small groups,
Try to choose children whose parents are eager to participate in the workshop and are prepared to contribute as equals in the problem-solving and aid-building process.
Examples of Assistive Technology Designed and Made for Children in the Bogota Workshop
Daniel is a 10 year old boy with cerebral palsy. We first visited him in his home (photo on right). Daniel is fairly intelligent, but has a hard time forming words. Mostly with gestures, he indicated that what he wanted most was to be able to do more things for himself, like sit upright and eat and draw.
The combination of athetosis (involuntary movements) and spasticity made it very difficult for Daniel to sit in his ill-fitted (donated) wheelchair. His legs and back would stiffen suddenly and he would slip forward out of the chair. The slippery canvas seat was so streched in front that it sloped downward, acting like a slide.
In the workshop, the group working with Daniel examined and evaluated his needs and possibilities, with his and his mother’s help. They found that by stabilizing his legs with the knees bent back slightly, under the seat, he had much less spasticity (uncontrolled stiffening) in his legs and whole body.
They drew up a plan for modification of the wheelchair. This included:
reclining the seat backwards
a separator between his knees
a seat belt at 45 degrees, low and tight
footrests and leg supports to hold his knees at less than a right angle.
Karen is a bright, very active little girl with athetoid cerebral palsy. She cannot speak but communicates well with her own sign language. She does most things well and goes to school. But she has trouble writing and drawing because of the uncontrolled motion of her arms. Her group decided to make her a “communication board” with pictures, words and hand signs to help her express her needs better and to learn to read and sign.
Jose and Alan
Jose and Alan, 8 and 12 years old, are two brothers with muscular dystrophy. We first visited them in their hillside house, climbing 50 steps to get there.
Alan can no longer walk and Jose has increasing difficulty. He is developing contractures in his heel cords. Given the difficult access to the home, it is especially important that he retain his ability to walk as long as possible—and that is his biggest wish.
With his weak legs Jose falls and hits his head so often that he has swellings, like little horns, on each side of his forehead. Because of his fear of injuring his head he doesn’t walk as much as he needs to to keep fit.
With the help of his father, the group also made for Jose a device to help him stretch his tight heel cords. It is a wooden wedge on which he bears his full weight first on one foot, then the other. The angle of the wedge can be gradually increased as his heel cords stretch. This exercise should help prevent contractures and keep Jose walking longer.
Alan is probably beyond walking, but has other pressing needs. He gets colds, sometimes pneumonia. He has trouble coughing up phlegm. He needs deep breathing exercises to improve his lung capacity and cough better.
To strengthen his lungs in a fun way, the group had Alan blow whistles and flutes. They also made a “blow toy” with a plastic bottle and straw, with bits of foam plastic in the bottle. The two boys can play to see who can lift the “snow storm” higher. The exercise may help both boys live longer.
Fernanda is a 5 year old girl who has spina bifida and and a severe spinal curve. The huge donated wheelchair in which she slumped was worsening the curve.
Fernanda herself helped her group design an insert for her wheelchair to help her sit in a better position.
The foam back is sculpted to protect her back and help prevent the curve from worsening. With her new seat Fernanda sits in a much better position and feels more comfortable. This will slow the collapse of her spine and perhaps add years to her life.
David is a 13 year old boy with spasticity who can walk holding on to something, but with knees bent from contractures.
David’s wheelchair is too wide to fit into the bathroom. The group thought to make him a narrow wheeled stool, but his foster father suggested putting a railing from the doorway to the toilet. “That way he will practice walking whenever he needs to go.”
With the foster father taking the lead, the group made a night-splint out of a strip of strong plastic. The spring-like action of the plastic gently helps to straighten David’s leg. The group learned the importance of teamwork.